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Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd

Using a Community-Based Participatory Process in Creating a School-Based Health Center Obesity Intervention for Multi-ethnic Teens. Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd Sally Davis, PhD Nina Wallerstein, DrPH.

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Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd

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  1. Using a Community-Based Participatory Process in Creating a School-Based Health Center Obesity Intervention for Multi-ethnic Teens Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd Sally Davis, PhD Nina Wallerstein, DrPH 1st Annual UNM National Health Disparities Conference May 24, 2011

  2. Background • Overweight (BMI 85th-95th percentile) and obesity (BMI ≥95th percentile) disproportionately affect certain racial and ethnic populations. • Nationally, Hispanic boys and non-Hispanic Black girls experience significantly higher BMI rates than their non-Hispanic White counterparts. • In New Mexico, American Indian youth have the highest rate of obesity (17.8%), double that of White youth (8.7%); Black (13.5%) and Hispanic (12.8%) youth also have high rates, about one -third higher than White youth.

  3. Background • Promising strategies for intervention with teens include: • Targeting locations (e.g., school) where adolescents spend the majority of their time • Motivational interviewing • Use of media • Intervention is based on the Transtheoretical Model or Stages of Change • Progress through a series of stages

  4. Adolescents Committed to Improvement of Nutrition and Physical Activity(ACTION) • Phase 1: Use an adaptive community-based participatory research approach to develop a school-based health center intervention for overweight teens • Create DVD and clinician tool kit • Phase 2: Feasibility testing of the school-based health center intervention against standard care for weight loss R21 HL092533 NIH/NHLBI

  5. Methods (Phase 1: Formative Research) Semi-structured interviews with OW/OB teens (N=7) and with parents (N=8) of OW/OB teens from two participating high schools ACTION Advisory Council meetings: 7 OW/OB teens and 5 parents of OW/OB teens + Feedback from 2 school-based health center providers and program manager Create strategies for DVD and provider toolkit.

  6. Parent and Student Interviews • Purpose—formative data collection to help guide intervention development • Served as basis for ACTION Advisory Council • Creation of DVD and provider toolkit • Method—semi-structured qualitative interviews with purposefully selected adolescent and parents

  7. Parent and Student Interviews: Demographics

  8. Parent and Student Interviews Interview Domains: • Teen/Parent views on: • Typical daily routines (focus on nutrition and physical activity) • Use of media (cell phones, music, computers, TV/movies, etc.) • Perspectives on health and obesity (barriers and facilitators to being healthy; change motivators) • Intervention Development (DVD content, group vs. individual, etc.)

  9. Parent and Student Results Parent themes: • Difficult to motivate kids • Kids not worried about obesity and consequences • Emphasize importance of parents as role models • Schools as “unhealthy” environments—food, lack of PE and health classes

  10. Parent and Student Results Adolescent themes: • Less concerned about long term problems • Adolescents busy—school, activities and work • Define health more as “functional” (what can I do) than illness status • Receptive to working with SBHC provider; need social network support

  11. 1) Translation of Themes to DVD • Challenge of motivation • Teens: tap into internal motivation • “Functional” health status

  12. 2) Translation of Themes to DVD • Inadequate exposure to health/nutritional information (no PE or health classes) • Navigating unhealthy environments

  13. 3) Translation of Themes to DVD • Adolescents busy (school, activities and work) • Feasible, accessible options needed

  14. DVD—Style and Content • Hire a Pro: Chris Schueler (Christopher Productions) • Make it “HOT, HIP and COOL” • “Kids like us”, “problems like ours” (sources of internal motivation) • DVD not meant as full solution but catalyst

  15. Weight loss guidelines Motivational interviewing Parent publication: supporting teens, stocking the refrigerator, cheaper food choices, recipes Displays for clinic Session tools: weight history assessment diet/physical activity assessment goal setting MyPyramid.gov activity/food journal label reading portion tips breakfast fast food eating at school drinks snacks local physical activity resources Provider Toolkit Content

  16. Conducting formative assessment research using an adaptive participatory process was an effective way to develop culturally appropriate and tailored intervention materials in multiethnic school settings. Our experience demonstrates the importance of partnership formation in the creation of contextually sensitive interventions. Conclusions

  17. Questions?

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